Nursing Elites

1. A nurse is assessing a client who has schizophrenia and is experiencing negative symptoms. Which of the following findings should the nurse expect?

• A. Hallucinations
• B. Delusions
• C. Flat affect
• D. Paranoia

Correct answer: C

Rationale: The correct answer is C: Flat affect. Negative symptoms of schizophrenia involve deficits in normal emotional responses or other thought processes. These symptoms include a flat affect (reduced emotional expression), social withdrawal, and avolition (lack of motivation). Hallucinations and delusions are characteristic of positive symptoms, which involve the presence of abnormal behaviors or experiences. Paranoia is more associated with delusions rather than negative symptoms.

2. A community health nurse is teaching a group of clients about first aid for different types of wounds. Which of the following client statements indicates an understanding of the teaching?

• A. I should apply clean dressings over blood-saturated dressings and hold pressure.
• B. I will rinse the wound with hot water to cleanse it.
• C. I can remove the dressing once the bleeding stops.
• D. I should apply antibiotic ointment directly to the wound.

Correct answer: A

Rationale: The correct answer is A because applying clean dressings over blood-saturated dressings and holding pressure helps prevent disruption of wound tissue, aiding in the clotting process and controlling bleeding. Choice B is incorrect as rinsing a wound with hot water can cause further tissue damage. Choice C is incorrect as the dressing should not be removed once applied as it can disrupt the formation of a clot. Choice D is incorrect as antibiotic ointment should not be applied directly to the wound during initial first aid.

3. A child is prescribed ferrous sulfate. Which of the following instructions should the nurse include?

• A. Take with meals
• B. Take at bedtime
• C. Take with a glass of milk
• D. Take with a glass of orange juice

Correct answer: D

Rationale: The correct answer is to take ferrous sulfate with a glass of orange juice. Vitamin C, found in orange juice, enhances iron absorption. Taking iron with milk (choice C) is not recommended as it reduces iron absorption. Taking it with meals (choice A) can hinder its absorption due to other food components. Taking it at bedtime (choice B) doesn't affect absorption but might cause gastrointestinal upset in some individuals.

4. A nurse is admitting a client who has tuberculosis and a productive cough. Which of the following types of isolation precautions should the nurse initiate for the client?

• A. Contact
• B. Droplet
• C. Protective
• D. Airborne

Correct answer: D

Rationale: The correct answer is D: Airborne. Tuberculosis is spread through small droplets that remain airborne for longer periods, hence requiring airborne precautions. Choice A - Contact precautions are used for diseases spread by direct or indirect contact. Choice B - Droplet precautions are for diseases transmitted by large respiratory droplets that can travel short distances. Choice C - Protective isolation is not necessary for tuberculosis, as it is not spread through contact with the client.

5. A nurse is assisting with mass casualty triage following an explosion at a local factory. Which of the following clients should the nurse identify as the priority?

• A. A client who has massive head trauma
• B. A client who has full-thickness burns to the face and trunk
• C. A client with indications of hypovolemic shock
• D. A client with an open fracture of the lower extremity

Correct answer: C

Rationale: In a mass casualty situation, the nurse should prioritize the client with indications of hypovolemic shock. Hypovolemic shock is an immediate life-threatening condition resulting from severe blood loss, which can lead to organ failure and death. Prompt identification and treatment of hypovolemic shock are crucial to prevent further deterioration. While clients with massive head trauma, full-thickness burns, and open fractures require urgent care, hypovolemic shock takes precedence due to its rapid progression to a critical state.

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